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“Investigating views and opinions of
using Cannabidiol (CBD) to relieve
stress and insomnia.”
Sharjeel Kayani
326BMS Final Year Project
BIOMEDICAL SCIENCE
MARCH 2018
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ABSTRACT:
Insomnia is becoming a public health concern and costs the country £13.9 billion
annually. Stress may induce feelings of anxiety and insomnia. Cannabis contains
cannabidiol (CBD) which is thought to have some health benefits, as it can reduce
levels of anxiety. However, the use of CBD for therapeutic purposes remains
controversial amidst the scientific community. This study aims to investigate attitudes
concerning the therapeutic use of CBD for insomnia and stress relief, alongside the
relationship between gender and CBD use. A paper-based questionnaire was
distributed to 60 Biomedical Science students from Coventry University. The results
were analysed through quantitative and qualitative analysis.
Of the 60 respondents, there was an equal proportion of both genders. There were
18 CBD users in the respondent pool, more males were found to use CBD products
as opposed to females. Respondents stress levels varied, however, more CBD users
felt ‘very relaxed’ compared to non-CBD users. Individuals who consumed CBD were
statistically significantly more likely to have a ‘good’ sleep quality (p=0.049 <0.05) as
opposed to non-CBD users. Females were more likely to orally administer CBD as
opposed to males, but vaping was the most common administration method for both
genders. Females predominantly use CBD for ‘stress/anxiety’ relief, whereas males
primarily expressed ‘other’ motivations.
This study has revealed interesting insights regarding gender differences in use and
attitudes towards CBD. These findings may be explained by changes in socio-
cultural perception, and gender based neurological or gonadal hormone differences
in cannabinoid effects. The results provide cautious optimism that CBD is beneficial
for health purposes, particularly as findings regarding sleep quality and CBD usage
were consistent with previous research. Whilst CBD business markets continue to
thrive, future work is required on a larger pool of human respondents to confirm the
health benefits of CBD, and to generalise current findings.
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TABLE OF CONTENTS:
Introduction……………………………………………………………………….….6
Methodology……………………………………..……………………….…….……9
Ethical approval… …… … …… … …… … …… … …… … …… . .. . .. . .. . .. . .. . .. . . 9
Questionnaire design and data collection............................................9
Study population…………………………………………………….…….....10
Data analysis……………………………………………………………..…...…...10
Results……………………..………………………………………………………..…......11
Gender and age group of respondents……………………….……………....…11
Stress level of respondents……………………………………………….……...12
Sleep quality of respondents………………………………………………..…....13
Preferred concentration and consumption method of CBD………….………..14
CBD user’s motivation and feelings regarding CBD use………………...…….16
Qualitative data analysis………………………………………………….……….18
Discussion……………………..……………..……………………………………...……22
Gender differences in CBD use………….……………………………...……….22
Gender differences in CBD usage motivation…………………….…….….…...22
Gender differences in CBD administration methods……………………..…....23
Differences in stress levels and sleep quality between non-CBD/CBD
users………………………………………………………………………………...24
Limitations and future work…………………………….……..…………..………25
Conclusion……………………..……………………………………………….…………26
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LIST OF ABBREVIATIONS:
CBD Cannabidiol
CBN Cannabinol
CB1 Type 1 Cannabinoid Receptor
CB2 Type 2 Cannabinoid Receptors
ECS Endocannabinoid system
EPM Elevated plus maze
GR Glucocorticoid receptor
PTSD Post-traumatic stress disorder
RCT Repeated combination tests
REM Rapid eye movement
SAD Social anxiety disorder
TA Thematic analysis
THC Tetrahydrocannabinol
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LIST OF FIGURES:
Figure 1 – Gender of CBD questionnaire respondents
Figure 2 – Stress level in the last month of CBD questionnaire respondents
Figure 3 – Sleep quality in the last month of CBD questionnaire respondents
Figure 4 – Reasons why CBD users use CBD
Figure 5 – CBD users’ feelings after using a CBD product for the first time
Figure 6 – A thematic network for respondent’s views regarding positive statement
made by CBD user.
LIST OF TABLES:
Table 1 – Preferred CBD concentration and initial method of CBD use for CBD users
Table 2 – Summary of results
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INTRODUCTION:
Cannabidiol (CBD) is a non-psychotropic cannabinoid derived from a viscous resin,
produced by glandular trichomes in cannabis plants (Bossong and Iseger 2015). A
cannabinoid is a chemical compound which acts upon cannabinoid receptors in the
biological endocannabinoid system (ECS). The ECS is composed of endogenous
lipid-based neurotransmitters (endocannabinoids) and receptor proteins, expressed
in both the peripheral and central nervous systems (Bátkai, Kunos and Pacher
2006). The type 1 (CB1) and type 2 (CB2) cannabinoid receptors for cannabinoids
are the most prevalent cannabinoid receptors and are mainly expressed in the brain
and immune system. Vital components of the ECS include: the receptors, their
endogenous ligands (2-arachidonoyl glycerol, N-arachidonoylethanolamide);
enzymes involved in their synthesis and degradation, and cannabinoid antagonists
(Freund and Katona 2012).
The ECS is involved in regulating a variety of cognitive and physiological processes
including: pain sensation, mood, sleep and female reproduction. Research also
suggests the ECS has a modulatory effect on the functions of brain, endocrine and
immune tissues (Pertwee 2006). Additionally, it has a regulatory role in
glucocorticoid secretion in response to stress stimuli (Bingham et al. 2010). The
efficacy of cannabinoids in modulating specific features of behaviour relate to their
site of expression which correlates with their expression density (Pertwee 2008).
There are at least 113 different cannabinoids, however the most studied ones
include tetrahydrocannabinol (THC), Cannabinol (CBN) and CBD (Aizpurua-Olaizola
2016).
CBD appears to have positive implications in reducing levels of anxiety. A double-
blind trial was conducted to gauge the physiological and subjective effects a single
dose of CBD had on 24 untreated individuals with a social anxiety disorder (SAD)
and a control group of healthy individuals. Thereon, feelings of anxiety and
nervousness were stimulated through public speaking. The study found that SAD
patients who were given a placebo, had a substantially higher level of anxiety,
greater cognitive impairment and discomfort compared to the control group. Upon
administration of CBD to SAD patients, their levels of anxiety, cognitive impairment
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and discomfort in their speech performance were significantly reduced. Thus,
indicating that CBD may inhibit the fear of public speaking by having an anxiolytic
effect (Bergamaschi et al. 2011).
A case report investigated the therapeutic effects of CBD oil on a 10-year old female
with post-traumatic stress disorder (PTSD). The findings indicated that the female
experienced a decrease in anxiety, alongside improvements in both quality and
quantity of sleep. CBD oil also appears to offer a safer alternative to prescription
drugs, which had major side effects on the subject (Shannon and Opila-Lehman
2016).
Differences between genders exist regarding CBD consumption and its associated
effects. A cross-sectional survey study was conducted on 2374 individuals whom
completed an anonymised online survey. The study assessed variations in CBD use
effects and patterns, between gender. The results indicate that females used
cannabis products less frequently and in smaller quantities compared to males.
Additionally, females appeared to consume CBD through oral administration, as
opposed to males who preferred combustion techniques and vaporisers. The effects
of CBD varied, men were more likely to experience improved memory, enthusiasm,
increased appetite and musicality. Whereas, women were more likely to report
desires of doing household chores and loss of appetite after CBD consumption.
During periods of abstinence, females were less likely to report vivid dreams and
insomnia yet were more likely to report increased anxiety and nausea compared to
males (Cuttler et al. 2016).
A study on adolescent rats was conducted to investigate the ability of cannabinoids
to prevent long term effects of chronic exposure to restraint stress on cognitive
function. Specifically, the effect of chronic stress on glucocorticoid receptor (GR)
levels in the forebrain limbic system was measured. GR levels are implicated in
neuroendocrine and cognitive processes, mediated by the hippocampus and
prefrontal cortex. A deficiency in GR levels may lead to symptoms of depression.
Rats were tested for a longitudinal period of 30 days after treatment ended, to
assess the long-term effects of stress and cannabinoids. This study indicated that
cannabinoids may be beneficial in preventing some effects of chronic stress, such as
deficits in memory and learning which are associated with hippocampal and frontal
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lobe dysfunction. Thus, these findings support the development of therapeutic
approaches which target the ECS (Abush and Akirav 2013).
The mechanism involved in the anxiolytic and sleep effects induced by CBD was
investigated in a recent study. Repeated combination tests (RCT) were used to
measure anxiety levels in rats, which consisted of 10 minutes elevated plus maze
(EPM) and 50 minutes of open field activities for four days consecutively. The micro-
injection of CBD into the amygdala appeared to block the reduction in time spent in
both the open arms of EPM and centre arena of the open field in latter days. Thus,
confirming the anxiolytic effect of CBD. Furthermore, the results also showed that
CBD in the amygdala reverses rapid eye movement (REM) sleep reduction, which is
a characteristic side effect of acute stress (Hsiao et al. 2012).
Stress induces feelings of anxiety and may cause insomnia, which is recently to
becoming an eminent public health concern. It is estimated that 30-48% of the UK’s
population suffer from chronic insomnia (Baglioni et al. 2011) and the costs involved
are costing the country £9.22 billion annually (Cushing, Ellis and Germain 2015).
Various studies have suggested that CBD may reduce anxiety levels and have
sedative effects. However, not all scientists agree to the beneficial properties of
CBD, thus the idea of using CBD for therapeutic uses remains controversial. It is
proposed that individuals of higher stress levels and poor sleep quality will not be
users of CBD. Previous studies have also indicated that females are less likely to
use cannabis related products, thus it is proposed that more males will be users of
CBD products as opposed to females. To address the latter, the aim of the present
questionnaire-based study was to investigate attitudes concerning the therapeutic
use of CBD for the relief of insomnia and stress. Relationships between CBD use
and gender were also investigated.
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METHODOLOGY:
A questionnaire-based study was conducted on a sample of 60 participants from
Coventry University, aiming to gather information about attitudes regarding stress,
sleep quality and gender differences in CBD usage. This study utilised a paper
questionnaire which explored the latter to investigate patterns of CBD use between
gender.
Ethical Approval:
Prior to initiating the study, ethics forms, informed consent forms, risk assessment
and a draft questionnaire were submitted to gain ethical approval from Coventry
University’s Research Ethics Committee. Thus, data was only collected upon receipt
of an ethical approval certificate.
Questionnaire Design and Data Collection:
Initially, a pilot study was conducted on the first draft of the questionnaire in attempt
to reduce risk of ambiguity and to test both the clarity and validity of the
questionnaire design. Then, the questionnaire was edited based on feedback
obtained and the final questionnaire was constructed.
The questionnaire took approximately 10 minutes to complete; it consisted of 15
questions. A variety of question styles were utilized, such as: open and closed
ended, rating scale, dichotomous and semantic, to aid quantitative and qualitative
analysis. Open ended questions allowed participants to express their own opinions
and personal experiences. The questionnaire asked for information regarding stress,
sleep quality and CBD usage. Participants were verbally approached to take part in
the questionnaire and were given a background of the study through a participant
information sheet which explained the study purposes.
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Participants were assured regarding data protection and confidentiality. All
participants completed a consent form and were advised their data would be stored
for 5 years, after which it would be discarded confidentially by Coventry University.
Thereon, participants completed the short-printed questionnaire.
Study Population:
Volunteer Biomedical Science students from level 1 to 3 were recruited personally
around or inside the Health and Life Sciences building. The sample size was 60
participants, 30 males and 30 females. For ethical reasons, all participants remained
anonymous and were informed of this.
Data Analysis:
The collected data from the CBD questionnaire was manually inputted into Microsoft
Excel. Statistical Package for the Social Sciences was used to statistically test coded
questionnaire data. Chi-squared analysis was used to compare frequency of CBD
use in both genders to see if there was a statistically significance difference in CBD
use between genders. Associations between CBD use and stress levels, quality of
sleep and feelings after using CBD were also investigated through Mann-Whitney U
analysis. Open ended answers were not statistically analysed. Thematic analysis
(TA) was conducted to analyse qualitative data. Furthermore, summary tables and
chart figures were created to further analyse the data produced.
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RESULTS:
Gender and Age Group of Respondents:
A total of 60 students at Coventry University were approached and given the CBD
questionnaire; all respondents completed the forms yielding a 100% response rate.
All responses were inputted into Microsoft Excel. Demographic data was gathered
for respondents (n= 60) from the first two questions of the survey. All respondents
fell into the 18-30 age range.
A column graph (Figure 1) was produced showing the ratio of female and male
respondents whom do and do not consume CBD. This shows that there was an
equal amount of male (30) and female (30) respondents, of which the majority were
non-CBD users across both genders. Also, both genders consisted of a similar
amount of both CBD and non-CBD users. In total, there were 18 CBD users of which
8 were female, and 10 were male. Additionally, no statistical significance was found
between gender and CBD use (X2= 0.317, p=0.573 >0.05).
8
10
22
20
0
5
10
15
20
25
Female Male
Number of respondents
Gender
CBD user Non-CBD user
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Stress
Stress Level of Respondents:
Information regarding respondent’s stress levels was obtained from question 3, “How
stressed have you been in the last month?”. Respondents were able to choose from
options ranging from ‘Very stressed’ to ‘Very relaxed’, findings for all respondents
can be seen in Figure 2. The percentage of respondents for each stress level was
calculated based on the number of respondents who answered the question divided
by the number of total respondents for that question.
The level of stress varied between individuals. In general, most respondents (63.3%)
felt stressed to some degree, of which the majority were non-CBD users as depicted
5.0
6.7
1.7
11.7
5.0
3.3
10.0
10.0
28.3
18.3
0.0 5.0 10.0 15.0 20.0 25.0 30.0
Very relaxed
Relaxed
Neutral
Fairly stressed
Very stressed
% of respondents
Stress level of respondent
Non-CBD user CBD user
Figure 1 – Gender of CBD questionnaire respondents.
Collated figures from the CBD questionnaire which requested respondents to
state their gender. The orange bars indicate CBD users and yellow are non-CBD
users. The number of respondents is indicated on the Y axis.
Figure 2 – Stress level in the last month of CBD questionnaire respondents.
Collated figures from the CBD questionnaire which requested respondents to
state their stress level in the last month. The yellow bars are non-CBD users and
orange are CBD users. The percentage of respondents is indicated on the X-axis.
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by Figure 2. Again, of the 11.7% of respondents whose stress level was neutral, the
majority were non-CBD users.
Of the 25% of respondents whom felt either ‘relaxed’ or ‘very relaxed’, the majority
did not consume CBD. Generally, similar trends were observed in that there was a
higher proportion of non-CBD users in comparison to CBD users, despite the stress
level of the respondent. However, in contrast to the other 4 levels of stress, there
was a greater proportion of CBD users whom felt ‘very relaxed’ in comparison to
non-CBD users. Overall, although most individuals were non-CBD users irrespective
of their stress level, no statistical significance was found between stress level and
CBD use (U= 301, p=0.195 >0.05).
Sleep Quality of Respondents:
Respondents provided information on their sleep quality over the last month, through
answering question 4 “How would you rate your overall sleep quality in the last
month?”. Respondents were able to rate their sleep quality as: poor, ok or good. A
graphical comparison on sleep quality between CBD and non-CBD users can be
observed in Figure 3.
Most respondents (24) rated their sleep quality as ‘poor’, the second most popular
sleep quality rating was ‘ok’ (22 respondents). The proportion of both CBD and non-
CBD users was similar for those whose sleep quality was ‘poor’ and ‘ok’, whereby
there were more non-users than CBD users. However, there was a difference in
proportion of CBD and non-CBD users in those whom rated their sleep quality as
‘good’, because there were predominantly more CBD users (9) in comparison to
non-CBD users (5). Additionally, sleep quality scores for individuals whom use CBD
were statistically significantly higher than for those who do not use CBD (U= 492,
p=0.049 <0.05) when ‘good’ sleep was scored as 3, ‘ok’ and ‘poor’ sleep were
scored as 2 and 1 respectively. Therefore, those individuals whom consume CBD
statistically significantly rated their sleep as ‘good’ in comparison to non-CBD users.
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Preferred Concentration and Consumption Method Of CBD:
The respondent pool included 18 CBD users, whom completed additional questions
regarding their CBD use. All CBD consuming individuals answered question 10
about their preferred CBD concentration “What concentration (mg) of CBD do you
prefer?”, answer options included: 100mg, 300mg, 600mg and ‘Other (Please
specify).” As shown in Table 1, there were gender differences regarding preferred
CBD concentration. 100mg was the most preferred CBD concentration for both
genders. Lower CBD concentrations (100mg) were more popular amongst males,
whilst the contrary is true for females whom predominantly preferred 600mg. The
female who chose the ‘Other’ option stated 1000mg was preferred, whilst the males
said they were ‘not sure’ of their preferred concentration.
6
3
9
18
19
5
0
2
4
6
8
10
12
14
16
18
20
Poor Ok Good
Number of respondents
Sleep quality
CBD user Non-CBD user
Figure 3 – Sleep quality in the last month of CBD questionnaire
respondents.
Collated figures from the CBD questionnaire which requested respondents to
state their stress level in the last month. The orange bars are CBD users and the
yellow bars are non-CBD users. The Y axis indicates the number of respondents.
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Respondents also provided information on their CBD consumption technique when
answering question 13, “How did you initially use CBD?”. Despite a range of possible
answers, ‘Swallow/Ingest’, ‘Vape’ and ‘Other’ were the most prevalent method of
CBD use. None of the CBD users chose ‘Shampoo/conditioner’ or ‘Cream’ to
consume CBD, hence why they are not listed in table 1. Vaping was the most
popular method amidst both genders. More females preferred technique was
swallow/ingest in comparison to males.
CBD User’s Motivation and Feelings Regarding CBD Use
The questionnaire elicited CBD users to share their motivations for using CBD
through question 11, “Why did you use CBD?”. Respondents were able to choose
from a range of answers, as depicted alongside the findings for females and males in
Table 1 – Preferred CBD concentration and initial method of CBD use for
CBD users.
Collated figures from the CBD questionnaire, where CBD users were requested to
state their preferred CBD concentration and their initial method of CBD use. The
responses for females and males are shown in each respective row. The total
number of responses for both male and females are shown in the final row.
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Figure 4 A and B respectively. Neither males nor females chose nausea relief, hence
why it is not shown on Figure 4.
The most common motivation for females was stress/anxiety relief, whereas for
males it was other. Male respondents whom chose other stated reasons such as:
‘peer pressure’, ‘trying it out’, ‘curiosity’ and ‘seizures’. Pain relief was not the
motivation for any males (0%), whereas 7.10% females chose it. Twice the
proportion of females stated they used CBD for stress/anxiety relief, compared to
males. An identical proportion of both genders motivation to consume CBD was
insomnia relief and general lifestyle.
Between gender variations existed regarding how CBD users felt after using a CBD
product for the first time, as visually represented by the column graph in Figure 5
below. Question 12 asked CBD users “How did you feel after using a CBD product
for the first time?”, users were able to choose from a range of options including
awful, average and great.
Figure 4 – Reasons why CBD users use CBD.
Collated figures from the CBD questionnaire, where CBD users were requested to
state their reason for using CBD. The responses for females are shown in panel
A, whereas the responses for males are shown in panel B.
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Most females felt ‘great’ after using CBD for the first time, whereas males mainly felt
‘satisfied’. Most CBD users across both genders felt either ‘satisfied’ or ‘great’.
However, a greater proportion of females felt ‘great’ in comparison to ‘males’, whilst
more males felt ‘satisfied’ in comparison to females. An identical proportion (5.60%)
of males felt ‘awful’ or ‘dissatisfied’, whereas no female CBD users expressed such
feelings. The proportion of males and females who felt ‘average’ was equal.
Nevertheless, no statistical significance was found between the gender of a CBD
user and their feeling after using CBD for the first time (U= 25, p=0.203 >0.05).
Of the 18 CBD users present in the respondent pool, 2 male CBD users described
feeling negative effects when asked “Did you notice any disadvantages or side
effects after using CBD, if so please mention what they were?” on question 14. The
negative effects respondents stated were: fatigue, throwing up, anxiety and
Figure 5 – CBD users’ feelings after using a CBD product for the first time.
Collated figures from the CBD questionnaire, where CBD users were requested to
state their feelings after using a CBD product for the first time. The blue bars are
females and the orange bars males. The Y axis indicates the percentage of
respondents.
0% 0%
5.60%
16.70%
22.20%
5.60% 5.60% 5.60%
27.80%
11.10%
0%
5%
10%
15%
20%
25%
30%
Awful Dissatisfied Average Satisfied Great
% of respondents
Feeling after using CBD product for the first time
Female Male
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paranoia. Additionally, 16/18 (88.9%) CBD users did not state that they had
experienced any negative effects after CBD consumption.
Qualitative Data Analysis:
The TA process was applied to the qualitative data generated by question 15, “What
are your views regarding this statement, made by a regular CBD user?”. The
statement was “The use of CBD has benefitted my social life as it helped introduce
me to new friends within the community of CBD users. It also helps dealing with
being nervous when starting conversations with new people.” The two key themes
elicited during the process of TA were that respondents either agreed or disagreed
with the statement as seen in Figure 6.
The consensus was that the respondents whom answered the question agreed with
the statement. Each code generated within each subtheme was based on
respondent comments when answering question 15. For instance, they expressed
how CBD has had a beneficial impact on their social life “It helped with my social life”
and “This is true it helped me connect with other users”. A range of respondents
indicated that CBD was beneficial for health/therapeutic purposes as they said
“Agree, has helped with my social anxiety”, “CBD seems like a method for coping
with stress” and “It is good, it able to help someone who suffers from
nervousness/anxiety”. Nonetheless, some respondents disagreed with the statement
as evident by comments such as “I use it for personal use would disagree with
statement.”
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Summary of Results:
Through analysing the responses of participants whom completed the CBD
questionnaire, key differences between CBD and non-CBD users were discovered
across both genders. Key findings can be seen in Table 2 below.
Figure 6 – A thematic network for respondent’s views regarding positive
statement made by CBD user.
As the qualitative data was analysed by TA, a thematic network was created
showing themes, subthemes and codes which appeared within each subtheme.
The main themes are indicated by the ovals and are ‘agree with statement’ (green
oval) and ‘disagree with statement’ (red oval). The subthemes are indicated by
the dashed rectangles e.g. ‘CBD beneficial for health/therapeutic purpose’. The
codes within each subtheme are denoted by the red and green rectangles
respectively e.g. ‘CBD helps with social anxiety’. The coloured squares within
each rectangle, as indicated by the key, are related to whether the code
materialised in a comment made by a CBD/non-CBD user, or female/male
respectively.
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Table 2 – Summary of Results
Collated answers summarised from each question of the CBD questionnaire,
including p-values, their significance and interpretation of results.
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DISCUSSION:
Gender Differences in CBD Use
The current study investigated gender differences between CBD users. Previous
research suggests that females were often underrepresented and excluded in both
clinical and pre-clinical studies (Fattore and Fratta 2010). The concept of
investigating gender differences in interests and attention is an upcoming area of
importance in many fields of biomedical science research. In line with previous
research, it was found that more males were CBD users as opposed to females.
However, the results indicated minimal gender differences in CBD usage (Figure 1).
As the data was not statistically significant it means there is no credible evidence to
suggest that males are more likely to use CBD products in comparison to females,
yet there is no evidence to suggest the opposite. Nevertheless, these findings
remain consistent with previous research that suggest men use cannabis related
products more than females (Fattore and Fratta 2010).
Gender Differences in CBD Usage Motivation
Verbal discussions when conducting the study revealed that females were more
interested in trying CBD products and were more fascinated by it, in comparison to
males. This may be indicative of current changes in the socio-cultural perception of
the use of cannabis products amongst females, reflecting a new trend which
diminishes stigma towards cannabis related products (Carrie, Laurie and Michelle
2016).
As denoted in Figure 4, a higher percentage of women used CBD products for
medical/therapeutic purposes such as pain relief, stress/anxiety relief and insomnia
relief as opposed to men. Men mainly reported using CBD for ‘other’ reasons, which
included peer pressure and trying it out. This difference in attitude may be explained
by gender based neurological or gonadal hormone differences in cannabinoid
23
effects. For instance, research in rats which investigated gender differences revealed
that cannabinoid–induced behavioural effects have been associated with the effects
of activating oestradiol and testosterone in females and males respectively. Females
were more sensitive to cannabinoids induced effects when tested in a high-oestradiol
state (oestrous), in contrast to a low oestradiol state (dioestrous) (Craft and Leitl
2008).
Gonadal hormones such as oestradiol are implicated in regulating cannabinoid
receptor transcription (Berrendero et al. 2000), density (Borda et al. 2006), and
signal transduction (Alper and Mize 2000) in areas of an adult rodent brain,
suggesting that CB1 receptor may be sexually dimorphic. Thus, the endocannabinoid
levels and the CB1 receptor affinity and density vary in certain brain regions as a
function of the sex hormonal cycle (Bradshaw et al. 2006). Therefore, this research
supports the hypothesis that there are sex hormone-dependent differences in the
sensitivity of certain neural pathways triggered by cannabinoid treatment.
Nevertheless, cannabinoid pharmacokinetics and pharmacodynamics may also be
vital in explaining gender differences, potentially due to variations in fat tissue
distribution and muscle mass between females and males (Fattore and Fratta 2010).
However, the nature of the differences discussed have not been well explored and
thus require further research, particularly on human subjects.
Gender Differences in CBD Administration Methods
Females may have the tendency to be more discrete and are less experienced in
using CBD products in comparison to males. The present study also explored
gender differences in methods used to administer CBD. It was found that women
were more likely than men to swallow or ingest CBD products (Table 1). The latter
findings may be explained by research, which indicates that oral ingestion (oil,
tinctures, capsules) offer a more discrete and easier method compared to using
vaporisers (Galván et al. 2015). Preparation of a vaporiser requires more skill, and it
takes longer to achieve the same desired effects (Lalo, Pairaud and Soulet 2017). A
cross-sectional survey study, investigating gender differences in medical cannabis
24
users found that male users were more likely to use vaporisers and combustion
techniques, compared to female users who preferred oral administration (Carrie,
Laurie and Michelle 2016). Interestingly, this study found that vaping was the most
popular method between both genders (Table 1) and therefore only some of the
findings correspond with existing research.
Differences in Stress Levels and Sleep Quality Between Non-CBD/CBD Users
Prior research suggests that CBD has stress reducing, anxiolytic effects (Charles et
al. 2015). The therapeutic use of CBD for the relief of insomnia and stress was
investigated in this study. It was discovered that most individuals were non-CBD
users irrespective of their stress level (Figure 2), and there was no statistical
significance between stress level and CBD use. These findings appear to be novel
as they do not correlate with previous research. For instance, a double-blind trial
revealed that CBD may have an anxiolytic effect on SAD patients by inhibiting the
fear of public speaking (Bergamaschi et al. 2011). Additionally, a clinical study
conducted on rats indicated that CBD may have beneficial effects in preventing the
effects of chronic stress (Abush and Akirav 2013).
The lack of correlation between the findings of this study and existing research may
suggest that the design of the present study was flawed because all participants
were university students. Most students were already experiencing academic stress.
However, the CBD users whom stated they were ‘fairly stressed’ or ‘very stressed’
may have been in a period of abstinence. This may be explained by a cross-
sectional study which found that CBD abstinence can induce feelings of anxiety
(Cuttler et al. 2016). Furthermore, the current findings may be explained by individual
differences in CBD usage. CBD may not provide a stress lowering effect on all
consumers, or its effects may be proportionate to its concentration or route of
administration.
CBD users exhibited varying levels of sleep quality (Figure 3), however, respondents
who consume CBD statistically significantly rated their sleep as ‘good’ compared to
non-CBD users. This is consistent with previous research whereby a clinical study
25
conducted on rats found that CBD in the amygdala reverses REM sleep reduction
(Hsiao et al. 2012). Additionally, a case study on a PTSD victim who used CBD oil,
found that CBD improved her quality of sleep (Shannon and Opila-Lehman 2016).
Further research needs to be conducted to investigate optimal concentrations and
the potential risk of dependency upon CBD to fall asleep.
Limitations and Future Work
As with most questionnaire-based studies, the current study is limited by possible
bias in self reports, including: overstating any beneficial effects; diminishment of
negative effects; recall bias and potential placebo effect. Furthermore, asking
university students questions about stress and sleep quality may not be
representative of the whole population and a sample of 60 may be too small to
generalise findings. Thus, care must be taken when generalising these findings to
the general population. More elaborate research is required in the future to validate
the results obtained. Furthermore, there was a lot of confusion about the nature of
the study as many individuals thought CBD was illegal and for that reason were
reluctant to give honest answers or even take part in the study at all.
Whilst the findings provided intriguing insights into gender differences on attitudes
regarding CBD, further elaborate research is required to validate the results
obtained. Future work could consider redesigning the questionnaire to ensure best
practise is adhered to through utilizing guides such as “Hands-on guide to
questionnaire research” published by the British Medical Journal (Gary, Greenhalgh
and Petra 2004). A larger, more diverse pool of respondents could be obtained
through administering the questionnaire online, as this would allow generalisation of
the findings to the greater population. Additionally, further research could investigate
concentrations and the potential risk of dependency upon CBD to fall asleep,
alongside the specific effects of varying CBD concentration and CBD administration
methods.
26
CONCLUSION:
In conclusion, key findings suggest that 18/60 respondents were CBD users, of
which were predominantly male. Most respondents were either ‘very’ or ‘fairly
stressed’ and rated their sleep quality as ‘poor’. However, there may be some
therapeutic benefits associated with CBD because CBD users statistically
significantly had a ‘good’ sleep quality in comparison to non-CBD users. Ultimately,
although certain findings were of interest, further human investigations are required.
The knowledge that cannabinoid action is regulated differently between the genders
needs to be further explored.
The present study has highlighted potential benefits of CBD, alongside the need for
future research. Research should be aimed at clarifying the underlying relationships
between hormonal milieu and endocannabinoids. Gathering in-depth information is
crucial for developing endocannabinoid system-oriented drugs for selectively
targeting peripheral or central tissues, thus avoiding antagonistic effects in unrelated
tissue types. Brain imaging methods may also help facilitate translational and
mechanistic advancements.
Perhaps the potential short and long-term side effects of CBD may also be explored,
particularly if the public health concerns and cost implications of chronic insomnia
are to be tackled. CBD usage remains a controversial topic amongst the scientific
community. Yet, the global CBD business markets and social community continue to
thrive (Borchardt 2016).
27
TOTAL WORD COUNT: 4742
REFERENCES:
1. Abush, H., Akirav, I. (2013) ‘Cannabinoids Ameliorate Impairments Induced by
Chronic Stress to Synaptic Plasticity and Short-Term Memory’.
Neuropsychopharmacology 38 (8), 1521–1534
2. Aizpurua-Olaizola, O., Etxebarria, N., Navarro, P., Schibano, D., Simsir, Y.,
Soydaner, U., Usobiaga, A. (2016) ‘Evolution of the Cannabinoid and Terpene
Content during the Growth of Cannabis Sativa Plants from Different
Chemotypes’. Journal of Natural Products 79 (2), 324–331
3. Alper, R. H., Mize, A. L. (2000) ‘Acute and long-term effects of 17beta-
estradiol on G(i/o) coupled neurotransmitter receptor function in the female rat
brain as assessed by agonist-stimulated [35S]GTPgammaS binding’. Brain
Research 859 (2), 326-333
4. Baglioni, C., Battagliese, G., Feige, B., Lombardo, C., Nissen, C., Riemann,
D., Spiegelhalder, K., Voderholzer, U. (2011) ‘Insomnia as a predictor of
depression: A meta-analytic evaluation of longitudinal epidemiological
studies’. Journal of Affective Disorders 135 (3), 10-19
5. Bátkai, S., Kunos, G., Pacher, P. (2006) ‘The Endocannabinoid System as an
Emerging Target of Pharmacotherapy’. Pharmacological Reviews 58 (3), 389–
462
6. Bergamaschi, M. M., Queiroz, R., Chagas, M. H. N., Oliveira, D. C. G.,
Martinis B. S., Kapczinski, F., Quevedo, J., Roesler, R., Schröder, N., Nardi,
A., Santos, M, Hallak, J. E. C., Zuardi, A. W., and Crippa J. A. S. (2011)
‘Cannabidiol Reduces the Anxiety Induced by Simulated Public Speaking in
Treatment Naïve Social Phobia Patients’. Neuropsychopharmacology 36 (6),
1219–1226
7. Berrendero, F., Bisogno, T., Di Marzo, V., Fernández-Ruiz, J. J. González, S.,
Manzanares, J., Milone, A., Ramos, J. A., Wenger, T. (2000) ‘Sex steroid
influence on cannabinoid CB (1) receptor mRNA and endocannabinoid levels
28
in the anterior pituitary gland’. Biochemical and Biophysical Research
Communications 270 (1), 260-266
8. Bingham, B., Gorzalka, B. B., Gray, J. M., Hill, M. N., Hillard, C. J., Lee, T. T.,
Shrestha, L., Viau, V. (2010) ‘Endogenous cannabinoid signalling is essential
for stress adaptation’. National Academy of Sciences 107 (20), 9406–9411
9. Borda, E., Busch, L., Sterin-Borda, L. (2006) ‘Effects of castration on
cannabinoid cb receptor expression and on the biological actions of
cannabinoid in the parotid gland’. Clinical and Experimental Pharmacology &
Physiology 33 (3), 258-263
10. Borchardt, D. (2016) The Cannabis Market That Could Grow 700% By 2020
[online] USA: Forbes. Available from
<https://www.forbes.com/sites/debraborchardt/2016/12/12/the-cannabis-
market-that-could-grow-700-by-2020/#7d1b7dfe4be1> [22 March 2018]
11. Bossong, M. G., Iseger, T. A. (2015) ‘A systematic review of the antipsychotic
properties of cannabidiol in humans’. Schizophrenia Research 162 (1-3), 153-
161
12. Carrie, C., Laurie, K. M., Michelle, S. (2016) ‘Sex Differences in Cannabis Use
and Effects: A Cross-Sectional Survey of Cannabis Users’. Cannabis and
Cannabinoid Research 1 (1), 166–175
13. Bradshaw, H. B., Krey, J. F., Rimmerman, N., Walker, J. M. (2006) ‘Sex and
hormonal cycle differences in rat brain levels of pain-related cannabimimetic
lipid mediators’. American Journal of Physiology, Regulatory, Integrative and
Comparative Physiology 291 (2), 349-358
14. Carrie, C., Laurie, K. M., Michelle, S. (2016) ‘Sex Differences in Cannabis Use
and Effects: A Cross-Sectional Survey of Cannabis Users’. Cannabis and
Cannabinoid Research 1 (1), 166–175
15. Charles, R. M., Esther, M. B., Jorge, M., Maria, M. S. (2015) ‘Cannabidiol as a
Potential Treatment for Anxiety Disorders’ 12 (4), 825–836
16. Craft, R. M., Leitl, M. D. (2008) ‘Gonadal hormone modulation of the
behavioral effects of Delta9-tetrahydrocannabinol in male and female rats’.
European Journal of Pharmacology 578 (1), 37–42
17. Cuttler, C., Mischley, L. K., and Sexton, M. (2016) ‘Sex Differences in
Cannabis Use and Effects: A Cross-Sectional Survey of Cannabis Users’.
Cannabis and Cannabinoid Research 1 (1), 166–175
29
18. Cushing, T., Ellis, J. G., Germain, A. (2015) ‘Treating Acute Insomnia: A
Randomized Controlled Trial of a “Single-Shot” of Cognitive Behavioural
Therapy for Insomnia’. Sleep 38 (6), 971–978
19. Fattore, l., Fratta, W. (2010) ‘How important are sex differences in
cannabinoid action?'. British Journal of Pharmacology 16 (3), 544–548
20. Freund, T. F., Katona, I. (2012) ‘Multiple functions of endocannabinoid
signalling in the brain’. Annual Review of Neuroscience 35, 529–558
21. Galván, G. D., García, R., Guerrero, M., Pinedo López, J. (2015) ‘CANNABIS:
ALTERNATIVE REALITIES (CRA)’. Vertex 26 (120), 85-91
22. Gary, W. W., Greenhalgh, T., Petra, M. B. (2004) ‘Hands-on guide to
questionnaire research. Reaching beyond the white middle’. BMJ 328, 1433–
1436
23. Hsiao, Y., Yi, P.L., Li, C. L., Chang, F. C. (2012) ‘Effect of cannabidiol on
sleep disruption induced by the repeated combination tests consisting of open
field and elevated plus-maze in rats’ Neuropharmacology 62 (1), 373-384
24. Lalo, H., Pairaud, C., Soulet, S. (2017) ‘A Novel Vaping Machine Dedicated to
Fully Controlling the Generation of E-Cigarette Emissions’. International
Journal of Environmental Research and Public Health 14 (10)
25. Pertwee, R. G. (2008) ‘The diverse CB1 and CB2 receptor pharmacology of
three plant cannabinoids: delta9-tetrahydrocannabinol, cannabidiol and
delta9-tetrahydrocannabivarin’. British Journal of Pharmacology 153 (2), 199–
215
26. Pertwee, R. G. (2006) ‘The pharmacology of cannabinoid receptors and their
ligands: an overview’. International Journal of Obesity 30, S13-S18
27. Shannon, S., and Opila-Lehman, J. (2016) ‘Effectiveness of Cannabidiol Oil
for Pediatric Anxiety and Insomnia as Part of Posttraumatic Stress Disorder: A
Case Report’. The Permanente Journal 20 (4), 108–111
28. Stern, C. A. J., Gazarini, L., Takahashi, R. N., Guimarães, F. S., and
Bertoglio, L. J. (2012) ‘On Disruption of Fear Memory by Reconsolidation
Blockade: Evidence from Cannabidiol Treatment’. Neuropsychopharmacology
37 (9), 2132–2142
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ACKNOWLEDGMENT
I would like to thank my supervisor Dr. Patricia Lund for her consistent support and
advice throughout the duration of this study. I appreciate all the respondents who
took time to complete the questionnaire. I would also like to thank Maimoona Ahmed
for her help too.
Thank you.
